Malignant melanoma black skin cancer
Malignant melanoma black skin cancer, Causes, symptoms and therapies at a glance: The malignant melanoma of the skin, also called black skin cancer, is the most malignant form of skin cancer, cause is usually too high UV radiation.
Here you will find information about:
- Causes and risk factors
The malignant melanoma of the skin, also called black skin cancer, is the most malignant form of skin cancer . It occurs most frequently in the back of men, and on the lower back in women. Each year more than 21,000 people develop malignant melanoma in Germany, including about 10,000 women and about 11,000 men. In addition, there are about 9000 people in whom early melanoma is detected. The risk of developing a melanoma during life is about 1: 500 in Germany and 1:50 in Australia. Humans are particularly often affected in the middle age between 45 and 60 years. Melanomas can develop early neoplasms ( metastases ) in lymph nodes and other organs in spite of missing symptoms and a relatively small size. Decisive for the prognosis is an early removal of the tumor.
Causes and risk factors
Melanoma originates from the pigment-forming cells of the skin or mucous membrane, the so-called melanocytes. The causes are a strong UV exposure with recurring sunglasses (especially in childhood) as well as a hereditary predisposition.
Since every third melanoma develops from an already existing liver patch, special attention is paid to the number and appearance of the liver spots on the body. In principle, however, the more liver patches are present, the greater the risk of melanoma. The increasing number of illnesses in the last three decades is mainly attributed to changes in leisure habits and increased life expectancy. The long-standing idea of ”Braunsein = Gesundsein” was still not sufficiently corrected despite many reconnaissance campaigns. Today, more and more parents are aware that they are not allowed to expose their children to the sun without being exposed, but the number of new cases continues to rise every year because changes in behavior are likely to affect the frequency of melanoma only after a longer latency period.
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Appearance and symptoms
As a rule, patients with malignant melanoma have no symptoms at the time of diagnosis. Occasionally itching or a small bleeding from the tumor lead to a doctor’s visit.
Malignant melanomas of the skin may differ greatly in their appearance. They are mostly dark, brown or black spots. They can be flat, sublime (walking over the skin surface) or knotted.
If you notice any of the following changes to the skin, you should consult a dermatologist:
- A birthmark is or will become darker over time than other times.
- The color (pigmentation) within a painting is different, besides light ones also darker parts are found.
- A known birthmark is beginning to grow.
- A birthmark looks different from all others.
- One time it starts to itch, to soak or to bleed.
The dermatologist will examine the suspected skin spot with an epilamicroscope ( dermatoscope ). This is a magnifying glass with built-in lamp, which is held to the skin surface.
If the suspicion of a malignant melanoma is found during this examination, the corresponding area is usually removed and examined under the microscope. Only this examination can finally secure the diagnosis.
Melanoma under the fingernail;
If there is a suspicion that a conspicuous skin lesion may be a melanoma, the treating (skin) doctor will initiate further steps. First, he will take a picture of her general health (anamnesis) and ask about cancer cases in the family. A biopsy – the removal of the suspicious skin area and the subsequent microscopic examination – provides a definitive conclusion as to whether suspected tissue is a cancer.
If the cancer suspicion is confirmed, a series of other diagnostic examinations follow, Eg, blood tests and imaging procedures (ultrasound, X-ray, computed tomography, nuclear magnetic resonance imaging, skeletal spinal grafting). Imaging procedures may provide indications as to whether metastases have formed in lymph nodes or other organs.
If a melanoma is still thin and grows only in the upper skin, the healing chances are at 100%. If the tumor protrudes into the second skin layer, the so-called leather skin, it may have access to the blood and lymph vessels and may thereby spread throughout the entire body. The cancer cells can be transported from the blood to other organs (eg, lung, bone, liver, brain) and from the lymph into the lymph nodes . There, then, the growth of the daughter, the so-called metastases , grow.
The deeper a tumor has grown into the skin, the more likely it is to spread cancer cells. The further course of the disease is then determined by the growth rate of the scattered cancer cells.
A malignant melanoma must be completely removed by surgery . The size of the necessary operation is determined by the thickness of the tumor, which is determined by the size of the tumor.
If the tumor is more than one millimeter thick, the lymph nodes (also called the “sentinel lymph node” or “sentinel lymph node”), which are first in the lymph drainage of the affected skin region, should also be surgically removed and examined, including tumors between 0.75 and 1, 0 mm thickness if certain other risk factors should be present.This examination of the shieldguard lymphatic system allows a better prediction of the course of the disease and has possibly also effects on further operations or a drug ” adjuvant ” treatment Near the lymph nodes.
In Germany, an immunotherapy with interferon alpha is recommended for melanomas with a penetration depth of more than 2 mm (“vertical tumor thickness”), which is performed in addition to surgery (“adjuvant” therapy). Interferon alpha stimulates the body’s defense system to fight any remaining non-visible tumor cells. Various studies have shown that the administration of interferon-alpha can lead to an increase in survival in patients with an increased risk of metastasis. The precise form of interferon therapy must be discussed individually with the treating physician, since the effects and possible side effects should be weighed against each other.
Treatment for metastases
In addition to the operation of radiotherapy, immunotherapies, and also under certain conditions, so-called ” targeted therapy ” have already been developed (eg lung, bone, liver, brain). Chemotherapy , as well as combined chemo-immunotherapies, are now of secondary importance in most cases.
In the summer of 2011, a new immunological treatment with the substance (Ipilimumab) was approved for metastatic malignant melanoma. This substance leads to a long or permanent disappearance of the melanoma metastases in some of the patients. It appears that, as with all advanced melanoma treatments, it is important to be able to start treatment as early as possible.
A further immunotherapy, which has attracted great attention among experts, and which leads to good results in metastatic malignant melanoma, are the PD-1 antibodies pembrolizumab and nivolumab. However, in some patients, other treatments, eg with Ipilimumab or a BRAF inhibitor (see below).
A second breakthrough therapy approved in 2011 for metastatic melanoma patients is called vemurafinib and comes from the group of so-called “Targeted Therapy”, the targeted therapy against melanoma cells. Another substance with the same efficacy and some other side effects (dabrafenib) was approved in autumn 2013. These substances are used in patients in whom a certain genetic change (B-RAF mutation) can be found in the melanoma cell. Frequently high response rates (reduction of the tumors ) can be achieved with these substances. In some of the treated patients, long-term survival also appears to be possible through this treatment. The effects of vemurafenib and dabrafenib can be further improved if given together with further treatment, a so-called MEK inhibitor. An approval of the combination of these two substance groups is expected for the year 2015.
Various substances are available for chemotherapy (eg dacarbazine, temozolomide, fotemustin, carboplatin, paclitaxel). A long-term survival is very rarely possible by these therapies. However, a reconstruction of the metastases can be achieved, so that the symptoms related to the tumor are relieved.
Because the currently available treatment options for advanced malignant melanomas are still limited in their efficacy in spite of the new substances, affected patients are also recommended to participate in clinical trials. The German Guideline for the Supply of Melanompatients explicitly points out that participation in clinical trials with advanced melanoma with metastasization in internal organs (stage IV) is promising. In the center of melanoma research are in particular other immunotherapies, which are to activate the immune system against the cancer cells, active substances in the form of so-called monoclonal antibodies and combined therapies with immunological drugs and the “Targeted Therapy”, as well as the combination of various substances of this targeted therapy (Targeted Therapy ) Against melanoma cells. These combination therapies are very likely to further improve the treatment options for the metastasized melanoma.
In certified skin cancer centers an interdisciplinary, well-coordinated and individualized therapy at the highest level is made possible. As the treatment of metastatic melanoma becomes more and more complex, it is in the hands of experts.
The intervals at which follow-up at the dermatologist is necessary after primary treatment of a melanoma depends on the type and extent of the tumor.
The general recommendations of the German melanoma guideline take into account the stage and tumor size as well as the fact that a recurrence of melanomas is most frequent in the first five years (meanwhile, this guideline is also a well-understood patient guideline). Since relapses are still possible later, an aftercare for 10 years is generally recommended.
Stage IA (tumor thickness ≤ 1 mm without ulceration, no metastases)
Physical examination: 1.-3. Year every six months; 4-10th Year once a year.
Stage IB-IIB (tumor thickness ≤ 1 mm with ulceration or increased mitotic rate or> 1 mm with and without ulceration of the tumor, tumor thickness> 4 mm without ulceration, no metastases)
Physical examination: 1.-3. Year every three months; 4 + 5 year twice a year and 6-10 years. Year once to twice a year.
Sonography of lymph nodes: 1.-3. Year every six months; If no SLND was performed more frequently.
Determination of Protein S 100 in the Blood: 1.-3. Year every three months.
Stage IIC (tumors over 4 mm with ulceration) and stage III (with lymph node metastases)
Physical examination: 1.-5. Year every three months; 6-10th Year every six months.
Sonography of lymph nodes: 1.-3. Year every three months 4. + 5. Year to six months.
Determination of Protein S 100 in the Blood: 1.-3. Year every three months 4. + 5. Year every six months.
Other imaging studies (sectional imaging procedures (eg CT of the abdomen, lung, MRI of the head): 1-3 year every six months.
Stage IV (with metastases in other organs)
Individual aftercare tailored to the course of the disease
After the acute treatment a rehabilitation can be useful. In the case of physical impairments, the patients receive help in order to cope better in everyday life. However, competent support can also be helpful for the mental processing of the disease.